Impacts and mechanisms of child sexual abuse in women's impaired fecundity and pregnancy outcomes - One in four girls residing in the U.S. will be sexually abused before they turn 18. Child sexual abuse (CSA)
victimization is associated with an increased risk for morbidity, including adverse reproductive health outcomes
in women. In characterizing the associations between CSA and women’s reproductive health, previous work
has not fully accounted for selection bias and the role of developmental timing, abuse chronicity, and co-
occurrence with other child abuse types in determining outcome severity. These research limitations hinder our
ability to characterize and appropriately address adverse reproductive health outcomes among women who
are survivors of CSA. Moreover, the biological and psychosocial mechanisms that explain reproductive health
problems among female survivors of CSA remain understudied. Chronic inflammation and psychosocial
consequences of CSA, such as depression, substance use, a history of sexually transmitted infections hold
promise as potential mediating factors in these associations. Our study aims to examine the impact of CSA on
women’s impaired fecundity, pregnancy outcomes, and preterm delivery; and explore inflammation and
psychosocial mechanisms that may mediate these associations. Specifically, the aims of this study include
estimating the impact of CSA on women’s reproductive health outcomes (Aim 1); identifying patterns of child
abuse based on type, developmental timing, and chronicity, and the association of these patterns with
women’s reproductive health outcomes (Aim 2); and exploring inflammation and psychosocial mechanisms in
the association between CSA and women’s reproductive health outcomes (Aim 3). Our proposed study is a
secondary data analysis of the National Longitudinal Study of Adolescent to Adult Health (Add Health)
restricted use dataset. The Add Health cohort is a nationally representative sample of adolescents recruited
from grades 7-12 during the 1994-1995 school year and prospectively followed into adulthood across five
waves of data collection. Add Health’s latest data collection occurred when participants were, on average, 38
years old (2016-2018; N = 6,197 women). Among women in Add Health sample, approximately 25% reported
a history of CSA. This nationally representative data assesses CSA and other child abuse types, chronicity,
and age of onset, allowing for a more nuanced understanding of abuse clustering. For each aim, we will
investigate several adverse reproductive health outcomes, including difficulty in getting and remaining
pregnant, complications during pregnancy (i.e., high blood pressure, preeclampsia, protein in urine, and
diabetes), and preterm delivery. We will employ several analytical approaches for data analysis, involving
propensity score matching, mixed-mode latent class modeling, mediation testing, and logistic regression
analysis. The results of this study will advance strategies to prevent or mitigate impaired fecundity and
pregnancy sequelae in women who have survived CSA—ultimately reducing the burden of adverse
reproductive outcomes among girls who experience sexual trauma in their childhood and adolescence.
